Saturday, August 8, 2009

However primortsy of travel to the Middle Kingdom has not yet refusing to

, PrimaMedia .VLADIVOSTOK, August 9, PrimaMedia.Primorski Rospotrebnadzor received new instructions from the heads of departments of Russia Gennady Onishchenko. Travel in China are officially recognized as dangerous, writes the newspaper "Komsomolskaya Pravda".

- Inhabitants of the province does not recommend travel to this country because of the outbreak of pneumonic plague in the city Tszyketan, - said Vladimir Kiryakov, deputy head of the department of transport and supervision of sanitary protection areas of Rospotrebnadzor of Primorsky Krai.

According to recent data, the city of Qinghai Tszyketan provinitsii remains closed for quarantine. However, this distant province seaside tourists rarely visit.The distance from our borders to some of Qinghai to Novosibirsk, so it particularly popular with holidaymakers Chinese city enjoys.A beautiful city and the inhabitants of Primorye resorts - Harbin, Beijing, Dalian, Qingdao and Shanghai - are on the sidelines of an infected province.

- People, of course, interested in - not dangerous there now rest in China? But no one stays still refused - told the managers of one of the Travel Agents Vladivostok.

Information:

Symptoms of pneumonic plague (it is also called "Spanish") - chills, fever, headache, weakness, faintness. On the second day there are chest pain, a strong cough, shortness of breath.Болезнь передается воздушно-капельным путем. The disease is transmitted by airborne droplets.

. Incidentally, in recent years, the world's cases of pneumonic plague are rare.

NORFOLK, Va. - Eastern Virginia Medical School in Norfolk is one of the sites nationwide testing the swine-flu vaccine that's being developed by pharmaceutical company Sanofi-Aventis.

There are 15 adults 18 and older participating in the trial at the medical school. As part of the testing, participants get their first injection and then return 21 days later to receive a second dose and blood tests.

Volunteers will be told at the end of the study whether they received the vaccine or a placebo, and those receiving the placebo will be given the real vaccine.

According to preliminary research, the vaccine is shown to be safe. The testing is meant to confirm safety and the effective dosage. Volunteers for the study will be under close medical supervision throughout the trial.

NEW DELHI: Physicians, nurses and lab technicians across the world have started to get infected with H1N1 influenza virus.

According to CDC Atlanta, half of the medical personnel were infected during work and none had followed protective recommendations.

The fear, however, is that the number of infected individuals with some relationship to health care delivery will grow unless doctors are doubly careful.

India too is seeing positive cases of H1N1 infection in the medical fraternity.

Two doctors were on Saturday admitted at the Infectious Diseases Hospital in Kolkata with symptoms of H1N1 infection.

In Delhi, Ram Manohar Lohia Hospital's H1N1 screening centre chief and a colleague of his have been put under home quarantine for suspected infection. Three more doctors in the capital had tested positive for the contagious virus on Friday.

So why do doctors in hospitals, at airports and in labs need to be extra careful?

"Of the 280 doctors, three cases are positive till now, on account of certain laxities. They are on the front line, interacting with people coming into India from infected countries or taking their samples for testing. They are therefore most prone to infection, if proper protection isn't taken. Private labs must take adequate precautions. Lab technicians must wear masks at all times," Union health secretary Naresh Dayal said.

He added, "All positive cases of H1N1 among doctors in India till now have occurred due to accidental exposure."

So what precautions must a doctor take against H1N1?

According to scientists from the National Institute of Communicable Diseases, "They must wear their personal protective equipment at all times whenever going close to an infected patient. The doctor should not rely wholly on Tamilfu and think the anti-viral drug will provide 100% protection against infection. Popping Tamilfu can also be detrimental by building resistance."

Dr Randeep Guleria, HOD of medicine at the All India Institute of Medical Sciences, said doctors with busy Out Patient Departments (OPDs) must be extra careful.

"A patient may be carrying the virus but may have come to the OPD for an orthopaedic problem. Doctors, therefore, have to be careful. The OPD of the doctor must have good ventilation and all patient care equipment should be effectively cleaned every half hour," Dr Guleria said.

Experts said reusable equipment like a stethoscope should be decontaminated between each patient. Personnel should wear disposable gloves.

So what are the hygiene related steps every doctor should take?

Dr Ashok Seth, chairman, Escorts Heart Institute, said, "Wash hands frequently with soap and water before and after patient contact. Touch is a vital pathway for the virus to jump."

According to Dr Guleria, one should never forget that H1N1 is an extremely contagious virus even though it is still not that virulent.

"A doctor must maintain at least an arm's distance with a patient with flu-like symptoms and must be wearing a mask. He should also cover his nose and mouth with the hand or a tissue when coughing or sneezing," Dr Guleria said.

It seems the H1N1 Influenza virus is fast becoming entrenched in India. The country is now seeing an explosion of secondary cases of H1N1 infection --people who haven't travelled to an infected country but may have got the virus from an infected individual.

Of the 3,624 people tested till now, 782 were found to be positive. Of these cases, 511 have been discharged. India has reported two deaths.

A central team was sent to Pune on Saturday to assess the situation and institute appropriate public measures.

The worst was Pune. Except for one case in Pune -- a 34-year-old male passenger who travelled from UK -- all other 33 cases are indigenous, most of them reporting social or school contacts.

Of the 13 cases in Delhi, two have history -- an 11-year-old who travelled from Singapore and a 13-year-old who travelled from Manchester, UK. All other cases are contact of earlier reported positive cases.

Of the seven cases reported in Chennai, three are travel related cases. In Bangalore which reported 10 fresh cases of H1N1 infection, none had a travel history.

One of the two cases reported in Mumbai is a six-year-old who travelled from London.

The other case is a 53-year-old female who was referred to an identified government health facility in Mumbai on the night of August 7 with acute respiratory distress from a private hospital. She tested positive on Saturday afternoon and died around 4.30 pm.

Health screening of passengers coming from affected countries is continuing in 22 International airports. On Saturday, 47,246 passengers were screened of which 33,164 passengers were from affected countries. As many as 224 doctors and 151 paramedics are manning 81 counters at these airports. Till now, India has screened over 44.8 lakh passengers.

Asia-Plus» - new cases of death and disease in hemorrhagic fever Tursunzadevskom area there, said the «AP» Deputy Minister of Health, Chief Sanitary Doctor of the country Azamdzhon Mirzoev, thereby denying the information circulated by several media that the victims of the disease were seven people .

Among them - the head of infection of the central regional hospital 47-year-old Askar Umarov, as well as brothers Holmanovy - 50 and 47 years.Hearth infection was in the village Zieratut Jamoat Navobod Tursunzadevskogo area.

«The state of the two people who have the diagnosis confirmed, a stable, - he said.– All contact with patients of 24 persons are under the supervision of health workers, and we hope that tomorrow or Monday, they will be discharged from the hospital ».

Information: Haemorrhagic fever - viral disease localized natural rights, which the agent is transmitted mites and their vectors - rodents.Transmission occurs when the causative agent of tick bite, and when ingested the blood of patients on the conjunctiva, oropharynx, nasopharynx, and damaged skin of people exposed to sick people.Sick people are mostly engaged in agricultural, caring for livestock, harvesting hay.Although the virus is known already for half a century, a vaccine to prevent it does not exist yet.. Incitant fever was first isolated in 1956 in the Congo from the blood of the sick child.

Health experts are urging the public to stay calm after the first case of a Thai H1N1 flu patient developing resistance to the main drug prescribed to treat the virus was found.The discovery of a H1N1 strain which is resistant to the antiviral drug oseltamivir was made in laboratory tests at Ramathibodi Hospital. Virus experts and health authorities will meet tomorrow to review the national strategy on tackling H1N1 flu in the wake of the find.The meeting will discuss the need to reassess treatment guidelines, and stockpile the alternative antiviral drug zanamivir, said Deputy Public Health Minister Manit Nopamornbodee.The discovery comes as the Public Health Ministry has extended its distribution of oseltamivir to clinics across the country. This will lead to the drug being prescribed more, possibly further increasing the risk of resistance growing.Heath experts have cautioned that overuse of the antiviral drug may lead to drug resistance. Mr Manit called on the public not to panic."The discovery of a drug-resistant strain is common. We have told clinics to be careful when prescribing the drug," he said. Prof Dr Wasun Chantratita, chief of virology and molecular microbiology at Ramathibodi Hospital, said the drug-resistant strain was found in a Thai who had since recovered from H1N1.He said another case of antiviral resistance had been recorded in a seasonal-flu patient. The discovery of the two cases of drug resistance was made in laboratory testing of 50 samples of confirmed type A H1N1 virus.Of 15,000 samples sent for testing, 10,000 were confirmed as influenza and of those 80% were the A H1N1 strain. "We can say anyone who contracts influenza now can be assumed as having H1N1," he said. "Interestingly, we have never found any patient who contracts H1N1 and seasonal flu at the same time."About 80% of seasonal flu patients are drug-resistant, so the chances of H1N1 patients being resistant were also very high."But prescription of the antiviral drug is needed to reduce fatalities. As long as an antiviral vaccine is not yet available, it is necessary to use the drug," he said.Dr Thawee Chotpitiyasunont, chairman of a committee setting national health strategy on the flu pandemic, said monitoring of drug resistance must be stepped up.

The victim was西蒂艾莎(23 years), had studied at the Segamat Accounting Department of the University Technology Mara, originally scheduled to graduate this year.

死者的母親拉瑪（53歲）向《星洲日報》披露，她的女兒已被院方證實患上A型流感而逝世。

The deceased's mother, Rama (53 years old) to the "Sin Chew Daily," the disclosure that her daughter has been confirmed to be suffering from the hospital and the death of A-type influenza.

她說，她的女兒身體向來健康，只是長期患上鼻竇炎。

She said that her daughter has always been the health of the body, but long-term suffering from sinusitis.

西蒂艾莎have five brothers and sisters, she ranked No. 3 at home.

拉瑪說，女兒並沒有和家人一起住在甘榜武吉林登，為了方便上課，女兒和4名朋友在昔加末麻坡路魯伯峇都，合 租一間屋子居住。

Rama said that the daughter and the family did not live in the kampong-Wu吉林登, in order to facilitate the class, my daughter and four friends in Segamat Muar Batu Road, beg, sharing a house and live there.

拉瑪表示，她的女兒上週已開始發燒，過後去看醫生。

Rama said that her daughter has started a fever last week, after the doctor.

她以為是普通發燒，於是回家休養。

She thought it was an ordinary fever, then go home to rest.

她說，8月2日晚上，女兒在外宿的家突然呼吸困難，她的朋友就立即把她送入昔加末核心醫院。

She said that the August 2 evening, sleeping out the home of her daughter in a sudden difficulty in breathing, her friend immediately took her into the heart of the Hospital Segamat.

She pointed out that her daughter and another three roommate Mara Technology University of friends, are infected with influenza A, of which 2 were discharged, 1 still in hospital isolated for observation, the only daughter of her sudden illness on the 4th in an emergency, and immediately was sent to hospital intensive care unit, and unfortunately passed away in the evening Friday.

今日（週六，8月8日）早上11時許，西蒂艾莎的遺體已運回甘榜武吉林登下葬。

Today (Saturday, August 8) morning, 11 am,西蒂艾莎his body had been shipped back to the kampong-Wu吉林登buried.瑪拉工藝大學派了一輛巴士載送她的同學出席葬禮，所有學生皆戴上口罩出席葬禮。

校內沒其他感染病例

No other infections in schools

一名瑪拉工藝大學的代表週六早上在葬禮上透露，死者和3名同住的學生是在外頭感染A型流感，校內目前沒有發 生其他感染病例。

Mara University of Technology, a representative of the funeral on Saturday morning revealed that the deceased and three students living in the A-type influenza infection outside the school there is no occurrence of other infections.

他說，瑪拉工藝大學仍照常上課，並在校內派發口罩給所有學生。

He said that the Mara University of Technology will operate as usual still and masks distributed to all school students.

KUALA LUMPUR, Aug 8 — Medical authorities today reported three more deaths related to Influenza A (H1N1) bringing total fatalities to 18 while another 53 new cases were recorded in the country.

“The situation is very serious. We need the public to cooperate with the authorities to stop the spread of the virus. We can do it if we cooperate,” Health Minister Datuk Seri Liow Tiong Lai said here.

Among the three new deaths is a five-old-boy suffering from encephalitis who died at the Kuantan Hospital yesterday while another four year-old with hyperthyroidism and pneumonia died the same day at the Sultanah Aminah Hospital in Johor Baru. The child had had fever, cough and running nose for a week before seeking treatment last Sunday.

The last death was a 63-year-old asthmatic from Selayang with tuberculosis and pneumonia who died at the Selayang Hospital late Thursday.

On July 8th, a family of 3 enter Vietnam from Canada. Father, Mother, Child all test positive. They have a dinner banquet that night to welcome the family back. 30 attend dinner. 17/24 got infected from that exposure. Child returns to school on 7/9 (Ngo The Times, Private School) . On July 19th test results come in. 3 teachers and 19 students are confirmed positive. On July 24th the total confirmed cases at the Ngo The Times school is 78. I stopped counting. The cases climb throughout Vietnam, stemming from that initial incident.

Anyone having physical contact with influenza A (H1N1) patients must be closely monitored afterward, whether or not they have symptoms, the Ho Chi Minh City health authority told a press briefing Friday.

The meeting was called amid rising number of flu patients throughout the country.

Nguyen Van Chau, director of the city Health Department, said several people in HCMC had tested positive for the H1N1 virus without showing any signs of sickness.

Chau said the virus would continue to spread, especially at crowded places including boarding schools.

Many healthy people visiting and working at hospitals that treat the flu have also caught the virus, he added.

Thong Nhat Hospital on Wednesday reported that five doctors and nine nurses had been infected. They are suspected to have caught the virus after examining five people last Friday. All five examinees also tested positive for influenza A (H1N1).

The city health department said during the briefing that it would continue to expand communication lines with the public on the matter.

The department said it would train all health officials in the city to treat the flu, also known as swine flu, as quickly as possible.

According to the department, only four health centers in the city are allowed by the Ministry of Health to conduct H1N1 examinations – the Tropical Diseases Hospital, Pasteur Institute, and the Children’s Hospitals No. 1 and No. 2.

The Health Ministry confirmed 35 more H1N1 cases Friday, raising the country’s tally to 1,078. The country’s first death from influenza A (H1N1) was a 29-year-old woman who died Monday in Khanh Hoa coastal province. 628 other patients have recovered fully.

All schools in Hanoi closed Friday in a bid to contain an outbreak of the flu after the first death, AFP quoted the city’s education authority as saying.

Officer Chanh Viet Thong of Hanoi Department of Education and Training told VTC News that the department has ordered schools to stop all activities that require students to congregate.

The schools can continue with other administrative or personnel activities, Thong said, adding that the department had consulted the Hanoi government before making the order.

“The school year will thus begin later than scheduled but students’ health is the most important thing.”

The new school year officially begins on August 17, but schools began opening at the beginning of the week.

In Hanoi, three schools already recorded flu infections among their students, according to the department.

US discourages quick school closure

New US guidelines for the H1N1 flu pandemic released Friday discourage the early closure of schools, unless the virus becomes worse.

“We know now that closing schools is not the best option in most cases,” Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, told reporters in a telephone interview.

If the virus starts to spread faster when school starts again this month and next, officials should try other means to slow its spread, such as keeping students more widely separated and stressing hand hygiene, the guidelines recommend.

“The potential benefits of preemptively dismissing students from school are often outweighed by negative consequences, including students being left home alone, health workers missing shifts when they must stay home with their children, students missing meals, and interruption of students’ education,” the guidelines read.

Schools for pregnant mothers and disabled children are an exception, as such people are at high risk from flu.

About 55 million students attend 130,000 public and private schools in the US, and seven million staff work there, according to the Department of Education.

Schools are a breeding ground for infections, but studies have shown that unless they are closed for the entire flu season, closing them only delays an inevitable spread.

“The decision to dismiss students should be made locally and should balance the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption,” the guidelines read.

Sick students should be sent home promptly, they stress. Staff should try innovative ways to keep students apart if flu does show up at a school – for instance, spreading desks apart and keeping classes from mixing.

Previous estimates 500 people are infected with a death, but now this figure increased 3-4 times in some countries. Indonesia more than 650 of those deaths were 3, Malaysia 15 deaths in over 1,500 people infected.> Nỗi our patients with treatment monitoring H1N1 / Got a question about common H1N1

On the world, have number of new H1N1 continue increasing, many countries have recorded cases of death. Notification by the Center and for disease control Europe, to 7/8/2009, the world has more than 200,000 of the positive, in 168 countries, territories. In which nearly 1600 cases of death.

In Vietnam, the number of new infected increased each day, up to date with 70 songs. To date 7 / 8, there are 1,078 positive cases, a person has died.

However, many health experts are concerned the situation and will be more complex than the upcoming winter.

Dr. Jean Marc Olive, Chief Representative of World Health in Vietnam that: "In winter, H1N1 virus will work as more powerful. Winter also means the flu season, when it is difficult to distinguish between the H1N1 influenza season. Besides, this is also the time study should be capable of spreading disease to growing wide. "

Dr. also note, in Vietnam, H5N1 virus is still circulating so people need to alert. When does the flu, they must be examined to classify the H5N1 or H1N1.

Prediction of the combination of H1N1 with H5N1 virus in the near future, Dr. Olive said: "The H1N1 virus associated with H5N1 is, but my worry is the combination of H1N1 influenza season and easy more. As flu season is also spread from person to person through contact, but H5N1 is spread from poultry to people. "

According to doctors, at this time, if students, working people should be sick at home, avoid spread the disease to others. When the sick or the symptoms after a day in school, work.

On 7 / 8, Ministry of Health has made 10 recommendations to prevent H1N1 flu in the workplace. In particular, note: - Flu H1N1 spread through respiratory contact with the drops of saliva and more nose or throat of patients or objects infected with the virus and then raise the nose, mouth.- Diseases spread quickly from person to person during the previous day from 1 to 7 days later from the disease have symptoms. People infected with the virus can be transmitted even when the disease manifests no symptoms. - The surface of the desk, the door handle, computer keyboard, the background to make regular hygiene and the same, limited use of air-conditioned (especially air-conditioned centers), open ventilation .- The basis of labor, employers must address hospitals and clinics last backup, phone number hotline to contact us in time ...

It has been a few days since I was able to sit down and study the latest news coming from South America. A combination of heavy work and helping my wife through her latest round of chemotherapy combined to distract me for over a week.

Once I was able to concentrate on the latest developments, I was shocked but not surprised. Needless to say, the news is quite disconcerting.

I want to take you back to my blog of July 17th, when I predicted that deaths due to confirmed H1N1v in Argentina would exceed those in the United States by the end of July. It took an extra week, but that gap has finally been closed --depending on how you parse your words.

The latest information coming from the CDC indicates a confirmed total of 353 deaths from swine flu. But Argentina just released new, two-week numbers which raise their death toll to 337.

But wait, there's more. According to the Guardian UK newspaper story, the Argentine government is waiting for positive pathology on another 400 deaths. If even a third of these are confirmed H1N1v, that will catapult Argentina to the top of the world's death list. Hat-tip to Cindy of Nerstrand, MN.

So what, you might ask. Well, two things should leap out at you. First, Argentina has just under 41 million people, according to the CIA. That means Argentina has just over one-seventh the population of the United States, yet it now effectively leads the world in deaths. If the United States had, say, 2,600 deaths from swine flu, that would be a comparable ratio relative to population.

Second, recall that this is Argentina's flu season. The Guardian article discusses that 750,000 confirmed cases of swine H1. I am sure that is just an estimate and not actual swabs. But the number of deaths could be double what is being officially reported, if the 400 unknown results become positive.

This strains further an Argentine government that was the textbook example of how NOT to handle risk communication. In my recent Fox News Channel interview, I was asked if all my warnings could incite panic -- especially my instruction to pregnant women that if they feel anything remotely like flu symptoms, they need to get hold of their doctor, pronto.

No, I responded. It is the absence of information that produces panic, not the presence of honest data. I also reminded the reporter of the work of Dr. Peter Sandman and his advice to treat the American people as adults and give them the skinny exactly as it is.

It was also gratifying when, the very next day, the CDC issued the exact same advice/warning.

Anyway, back to the Argentine government. When H1N1v broke out, they acted as if the virus never existed. No, not here. Move along. When it became painfully apparent the virus was in Argentina and people were dying from it, only then did the government do an about-face and started engaging their pandemic plan.

It is absolutely amazing how governments full of well-educated people can make such terribly dumb decisions.

Further, there seems to be quite the debate raging as to whether or not the virus has indeed mutated in South America. Back in June, the Brazilian research facility Instituto Adolfo Lutz has been in existence since 1892, and was renamed to honor the former University of Bern (Switzerland) scientist. Its core competencies include (from its Website):

Currently, the Adolfo Lutz Institute is recognized internationally for its competence to respond to incidents in their area of expertise, having been accredited by the Ministry of Health and National Public Health Laboratory and Reference Laboratory Macroregional. It Collaborating Center of the Joint FAO / WHO for monitoring of contaminants in food. Reference Center for Analytical Quality Control of Mycotoxins and Residues of Pesticides, National Coordinator of the Program for Monitoring of foreign substances in food, the National Reference Center for Laboratory Diagnosis of AIDS; Collaborating Center of the Pan American Health - OPS areas of arbovirus, influenza virus and production of immunobiological and PAHO Collaborating Center for Cell Cultures.

Anyway, this prestigious WHO collaborating center (think if St. Jude had found such a change!) has typed the first known mutation of the virus' hemagglutinin (the "H" in "H1N1"). Hemagglutinin is what sticks the virus to the cell wall in your respiratory tract (think of those velcro ping-pong balls that stuck to felt dartboards from back in the day). An antigenic change in hemagglutinin could make the virus much easier to catch (search umbrellas and coneson this blogsite for a full description of this phenomenon).

The (236 year-old) patient was hospitalized on April 24 at the Institute of Infectious Diseases Emilio Ribas (Brazil) and is fully recovered.

Respiratory secretion sample of this patient was subjected to molecular rt PCR methodology (§ reaÃthe polymerase chain in real time) with probe specific for the new subtype H1N1 by the team of molecular biologist Claudio Sacchi, and the result for the new viral subtype .

Following the research the team of virology Terezinha Maria de Paiva, the Institute Adolfo Lutz, São Paulo, isolated at the end of April that the new strain is now known as A / Paulo/1454/H1N1 are following the rules of the World Health Organization . The virus isolation was performed in cell culture using the MDCK cells successfully in the first passage. In section electron microscopy of the Adolfo Lutz, Marli Ueda and Jonas Kisielius identified several virus particles from the infected culture. also the first observation.

The isolation of the virus provided the sequence of the genetic material of the Brazilian strain, experiments being performed by Dr. Cecília Luiza Simões dos Santos of the Instituto Adolfo Lutz.

The initial molecular characterization of strain A / Paulo/1454/H1N1 are involved the determination of complete sequences of two gene segments, segment 4, which encodes a protein Hemaglutina (HA) responsible for viral infectivity and for which antibodies are produced protectors, and segment 7, which encodes the matrix protein (MP) M1 and M2. The complete sequences of the genes HA and HB, the first determined for strains isolated in Brazil, are available in GenBank, a database that U.S. shared sequences obtained worldwide, which can be consulted by their respective numbers of access: GQ247724 (HA gene) and GQ250156 (MP gene). Molecular analysis indicated that while the virus segment 7 of A / Paulo/1454/H1N1 are shown to be completely conserved when compared to the reference strain A/Califórnia/04/H1N1, segment 4 showed a discrete number of nucleotide changes and of amino acids, with similar rates of around 99, 7% and 99.5% respectively. Detection of amantadine-resistance marker, comprising the amino acid asparagine (N) located at position 31 (N31) of the M2 protein in strain A / San Paulo/1454/H1N1, corroborates the literature that point be the new virus resistant to this class of antiviral compounds.

The debate started just after the sequencing of this new substrain of H1N1v was announced, and it continues to rage on flu sites such as Flutrackers to this very hour. The issue is this: Do these changes have a lot in common with the hemagglutinin from 1918? At first glance, the answer is yes. There was a lot of swine involvement in the 1918 virus, and so it would not be surprising to see this unique virus sort of "run home to Momma" when it comes to picking up mutations. Swine flu is a much closer antigenic descendant to the 1918 pandemic strain than is our seasonal H1N1! The fact that some of these mutations were first typed in the "Brevig Mission, Alaska" trip of Johan Hultin, circa 1997-98, and came conclusively from the 1918 virus, are somewhat unsettling.

It remains to be seen if this Brazilian mutation is responsible for the larger numbers of infected and dead in Latin America relative to population. Sao Paulo is Brazil's southernmost metropolis. It is about 800 miles from Buenos Aires, the capital of Argentina. The area also borders the capitals of Uruguay and Paraguay.

Let us shift to Mexico, which is reporting a new spike in human H1 cases. Are these cases the vanguard, the herald of the Second Wave? Or are these outbreaks simply vestiges of the first wave of the virus? Nobody knows yet, but there are more reports coming from the border region with Texas which indicates more Tamiflu resistance than originally thought.

This can be explained by the sudden and massive insertion of Tamiflu into the region in the Spring. Remember that Tamiflu does not break down in groundwater, nor does it break down in water treatment plants. So it is not surprising that the massive administration of Tamiflu in towns on both sides of the Mexican border might produce NA 274Y Tamiflu resistance.

We have seen this antiviral resistance many times before, both in seasonal H1N1 and in some cases of H5N1 human infection. Of course, the seasonal strain's resistance is far, far more prevalent.

One thing is sure: South America has suffered the most of all the regions of the world in this, the first wave of the H1N1v swine flu pandemic.

New York TimesAugust 6, 2009By ANDREW POLLACK As the swine flu spreads, many doctors and hospitals are turning to rapid tests that can determine within minutes whether an anxious patient has the flu. Sales of such tests are soaring.

But the tests have a severe limitation: They may fail more than half the time to detect swine flu infections, according to newly published studies and to experts in medical testing.

The low sensitivity of the tests is becoming a concern to health authorities because a false negative reading might prompt a doctor not to prescribe antiflu drugs.

It is also one of the big issues laboratory directors face as they prepare for what is expected to be a crush of flu testing this fall and winter. Numerous diagnostics companies are hoping to capitalize on demand for influenza testing.

The rapid tests “are missing a ton of flu,” said Christine C. Ginocchio, director of the division of microbiology, virology and molecular diagnostics at the North Shore-Long Island Jewish Health System in Lake Success, N.Y.

For seasonal flu, experts have long known about the low detection ability of the rapid tests. The new studies suggest the tests are no better, and possibly worse, at detecting the swine flu strain now spreading around the world, known formally as the novel H1N1 virus.

In a study published recently in The Journal of Clinical Virology, Dr. Ginocchio found that one rapid test detected only 10 percent of the swine flu infections that could be picked up by a more sophisticated laboratory culture. A different rapid test detected 40 percent. (Dr. Ginocchio is a consultant to Luminex, a company that makes a more accurate but slower test.)

The federal Centers for Disease Control and Prevention is expected to publish its own study of the rapid tests soon. Last week, it updated guidance urging doctors to be cautious in relying on the tests.

“We’re saying you need to understand the limitations of these tests,” Dr. Timothy M. Uyeki, an author of the C.D.C. guidance, said in an interview. “The clinician should not base a decision to treat or not treat on the basis of a negative result.”

But some doctors say there is no good substitute for the simplicity, speed and low cost of the rapid tests. Manufacturers of the tests say the products are helpful if used appropriately.

“When these tests are used properly, the performance is very, very good,” said John D. Tamerius, senior vice president for clinical and regulatory affairs at Quidel, which describes itself as the leading maker of such tests.

He said the company’s QuickVue flu test could detect 80 percent of infections if nasal samples were taken correctly and if the test was given early in the course of the disease, when more virus was present.

But in a letter to The New England Journal of Medicine in June, Navy researchers said the Quidel test missed half the swine flu infections detected by a more sensitive technique.

Spurred by flu test sales, Quidel’s revenue from infectious disease testing rose 70 percent in the second quarter from a year earlier, to $16.1 million. Among the big buyers was Mexico, which had an early swine flu outbreak.

Quidel, of San Diego, is now manufacturing tests as fast as it can. The company’s shares, which closed at $15.28 on Wednesday, have doubled since the flu outbreak started in April.

Other rapid tests makers include Inverness Medical Innovations, 3M, Thermo Fisher Scientific, Meridian Bioscience and Becton, Dickinson. With the exception of Meridian, these companies are much larger than Quidel and less dependent on flu tests.

Quidel estimates that about eight million rapid flu tests in total were sold in the United States in the 2007-8 flu season. The number is likely to jump this year.

More accurate tests are available but they generally require sophisticated laboratories. And results might not come for a day or more, making the tests of little use in deciding whether to prescribe drugs like Tamiflu, which are supposed to be started within 48 hours of the appearance of symptoms.

The rapid tests, by contrast, take only a few minutes to half an hour, and most can be done in the doctor’s office or emergency room, without a laboratory. That is appealing to some doctors.

“When parents come in with a kid with fever, they want to know what the fever is from and is there something they can do about it,” said Dr. Dorothy A. Levine, a pediatrician in Connecticut who uses the tests.

The rapid tests also cost only about $10 to $20, though some doctors might charge more, versus about $100 for a test using a sophisticated technique called the polymerase chain reaction, or P.C.R. While a negative result on a rapid test might not be reliable, a positive result, at least during flu season, usually does indicate a person has the flu.

The rapid tests do not tell if a patient has the swine flu. They say only if flu is present, or in some cases whether it is type A or type B influenza. The swine flu is type A, but so are many seasonal flu strains.

So more sophisticated tests, beside being used to double-check a negative rapid test result, are also needed to see if a positive test result is the swine flu.

Demand by patients to know if they had swine flu overwhelmed some public health and hospital laboratories in the spring, and some experts fear a repeat in the fall. “I definitely think there will be another crunch,” said Rosemary Humes, senior adviser for scientific affairs at the Association of Public Health Laboratories.

The C.D.C. has developed and distributed its own test for swine flu that runs on equipment made by Life Technologies. But the agency says it would be costly and unnecessary to determine whether every flu case is swine flu.

Quest Diagnostics, the nation’s largest clinical laboratory company, recently received an emergency authorization from the Food and Drug Administration to distribute a swine flu test to hospitals and other laboratories.

Luminex and Prodesse also sell tests to hospital laboratories that detect flu, though they do not specifically test for the swine flu. Because of the pandemic, “business is extraordinary for us,” said Andrew M. Shrago, chief marketing officer of Prodesse, a privately held company in Waukesha, Wis.

In May, the F.D.A. sent warning letters to Prodesse, Luminex and Becton, Dickinson, saying they were improperly claiming their tests were for swine flu. The companies removed the offending language from their Web sites.

The tests from the C.D.C., Quest, Luminex and Prodesse use the P.C.R. technique, which can amplify minute amounts of the viral genes, making those tests highly sensitive.

The rapid tests are more like pregnancy tests. They use antibodies to detect a protein from the virus. If that protein is present, a colored stripe appears on the test strip. But even a nasal sample from a patient with the flu might not contain enough of the protein to register a positive result.

DxNA, a company in St. George, Utah, says it hopes to have a one-hour P.C.R. swine flu test approved for emergency use this winter. Enigma Diagnostics of Britain hopes to introduce a similar test in 2011.hat-tip Pixie

HOUSTON, Aug. 6 (Xinhua) -- The death toll of the A/H1N1 flu in the southeast U.S. State of Florida had nearly doubled in the past two weeks, the state health officials reported Thursday.

As of Wednesday, Floridians who died of the new virus reached 41, from 22 two weeks ago, according to local health officials.

Miami-Dade County is the hardest-hit with 15 deaths since May. The latest victims reported in Miami-Dade County were 59- and 53-year-old men. No further information about them was released.

Wednesday is seen as a black day when nine new deaths were reported in Miami-Dade, Osceola, Hillsborough, Orange and Lee counties.

Since the pandemic declaration on June 11 by World Health Organization (WHO), the A/H1N1 flu has been spreading rapidly in the state.

The death toll and the conformed cases of the new virus have almost doubled in every two weeks, although most people who have become ill have recovered without requiring medical treatment.

If state health projections hold true, some 160 Lee County residents and 5,000 Floridians will die from the A/H1N1 flu in the next 18 months to two years, the average life cycle of a pandemic, said Jennifer James-Mesloh, the Lee County Health Department spokeswoman.

That's twice as many deaths as Lee County sees in a typical flu season, she added. "I think we do have to be more vigilant than we would in the past," said the spokeswoman. "We don't know if this virus is going to change on us. We don't know if it's going to mutate."

She said she does not want to spark public panic, but to remind people that they can take steps to prevent flu -- frequent handwashing, staying home when sick, getting vaccinated when the inoculations become available this fall.

The rapid increase of fatalities from the A/H1N1 virus seems unpredicted by the health officials and local citizens in the state.

The state surgeon general Viamonte Ros said recently that Florida is preparing for massive A/H1N1 flu immunizations, starting with schoolchildren when they return school later this month.

For A/H1N1 flu, WHO representative in Vietnam that, this disease starts spreading in the community. However, Vietnam must particularly note and alert when the virus HPAI H5N1 is still circulating and dangerous combination of H1N1 and H5N1 vaccine virus to create new more dangerous, in the more powerful.

Dr. Jean Marc Olive, head of the WHO representative in Vietnam also said that the ability to combine and H1N1 influenza season is easier. As flu season is also spread from person to person through contact, but H5N1 is spread from poultry to people.

Also in the Ministry of Health have reported that Vietnam has recorded 39 more cases positive for influenza A/H1N1, the total who have this disease to the 1043 positive cases, 1 deaths.

In Hanoi, Health Center, Tu Liem district confirmation 6-8 days, there have been 1 teacher High School Lomonoxop (Urban Area 2 My Dinh, Tu Liem, Hanoi) results positive influenza A / H1N1. Medical Center for Hanoi for Primary School in Nam Thanh Cong, Dong Da district had 1 case of a male grade 2 students are identified with positive influenza A/H1N1.

Starting from today, 7-8, units, schools in the province Hanoi will stop all activities focus students have until the following instructions by the Department of GD-Tel. This is the content of urgent which GD-ĐT Hanoi sent to the unit, through the schools, 6-8. The individual high schools have organized professional competition on 14-8 and preparing for the new school year 2009-2010 is conducted in accordance with the plan was proposed. During this time, schools should work in collaboration with parents of students to understand the health of school students and reported timely when unusual situations occur.

The treatment of influenza A/H1N1 in Vietnam has recorded the patient's treatment time longer unusual, then many times the test is positive for influenza virus A/H1N1.Dak Lak province in a patient is admitted and have positive results for influenza A/H1N1 from 24 / 7. Treated properly exposed it after 5 days, the test on 29 / 7, the result is not negative. 2 days later, patients continue to be tested and continue positive.

"This is the first patient to test the 4 th, after almost 10 days with new negative influenza virus A/H1N1," Mr. Tran Quy Tuong, Deputy Director General Management treatment (Ministry of Health ) said.

In Tien Giang, 5 patients with influenza A/H1N1 also fell into a similar situation.

Huan He also suggested the primary treatment should reserve Zanamivir filled rooms where a patient's resistance to flu drug Tamiflu. There is still the drug Tamiflu characteristics of the most popular in the treatment of influenza A/H1N1.

According to Nguyen Tran Hien, Director of Institute of hygiene and epidemiology on the central world has 3 vaccine virus A/H1N1 flu tamiflu resistance. "At the vaccine virus A/H1N1 flu in Vietnam is still stable, no changes dị time. The length of treatment such as mentioned above still negative after continued use of tamiflu, " he said Hien.

2 Chinese workers working in Vietnam and infected with influenza A/H1N1Hoang Dinh Hoan, Director of the Department of Health Lang Son province, said: "today, we discovered there are 2 workers in China to work in projects international venture, construction of good fun , the golf course (under Hoang Dong commune, City Lang Son) are high fever, cough and nearly 38 degrees. "

Department of Health does Lang Son province has sent samples of 2 patients subject workers down about this and epidemiology central to testing.2 projects where workers are working there are people working. Mr. Hoan said medical center for Lang Son province has khử trùng spray the entire project area and isolation of people who have close contact with 2 people this, to prevent disease spread and development of new disease.

On 7 / 8, Vietnam has recorded 35 more cases positive for influenza A/H1N1. In the south: 18 ca, north: of 8, Central 4 ca, Environment: 5 ca.Thus, up to 17h on 7 / 8, Vietnam has recorded 1,078 cases of positive, 1 deaths.

Number of patients was 628 members. 449 remaining cases are being isolation, treatment at hospitals, treatment facilities, monitoring community health status is stable, without serious complication.

Hanoi stop focusing studentsOn 6-8, Nguyen Huy Nga, Director Department of Health Department of the Environment and Ministry of Health, said that Vietnam has recorded 39 more cases of influenza A/H1N1 infection, in which 20 of the South, North 8 ca, 5 of the Central and Tay Nguyen 6 ca. Up to this time, the country has recorded 1,043 people infected with influenza A/H1N1, 1 in which deaths. There are still 434 people in isolation, treated at health facilities in health status is stable, without serious complication.The same day, Health Center, Tu Liem District - Hanoi has confirmed an additional secondary school teachers Lomonoxop influenza A/H1N1 infection. This individual teacher contact with students affected by the influenza A/H1N1. Brother of the teacher also has influenza A/H1N1 infection. Department of GD-ĐT Hanoi also has the urgent notice of flu A/H1N1. Accordingly, from 7-8, the school in Hanoi to stop immediately all activities focus students until the Department of GD-ĐT it next.

At the meeting BCD countries in preventing influenza and influenza A/H1N1 recently, according to Dr. Nguyen Huy Nga, Director Department of Department of Health and the environment in Vietnam and has spread 26 provinces and cities and 4 provinces to have the disease of the large chùm (Hanoi, HCMC, Dong Nai, Khanh Hoa).

Hanoi own continuity patients appear influenza A/H1N1 in schools and residential area on 5 / 8. At the epidemiological hygiene Central (VSDTTU) are in the process of evaluation of the disease. According to the evaluation by experts, this is the beginning of the season on.

Dr. Nguyen Tran Hien, Director of Institute of hygiene and from that beginning of season and to date, Vietnam is using the resources of test and tested by WHO and other sponsoring organizations. Up to now, exhausted and can only enough for 1 more week. Status Pasteur Institute in Nha Trang, Vietnam is also similar. Recently, WHO has also provided 500 additional samples of diagnostic products (testkit) with accuracy to 98.9%, the result after 15 minutes for the test. However, with the number of influenza A/H1N1 BN increases as the current number of samples and this is only enough to use 9 months.

(KPL) The number of confirmed cases of type-A (H1N1) flu has reached 162, one of whom died.The virus spread in eight provinces in Laos, reported the National Coordination Office of Contagious Disease Control and Prevention on 4 August.While the new type influenza A (H1N1) virus is now erupting in over 160 countries worldwide with 134,503 people infected with the virus and 816 deaths and it seems to further spread seriously, according to the World Health Organisation on 30 July.As a worsen result, the National Coordination Office of Contagious Disease Control and Prevention, on 5 August, held a lecture on new type influenza A (H1N1) virus and prevention approach to students and teachers of Comcenter College.Dr Bounlay Phommasak who is responsible for the National Coordination Office of Contagious Disease Control and Prevention, pointed to the adverse effects of new type influenza A (H1N1) pandemic worldwide. This virus led to high rate of casualty worldwide which tends to further rise.

Thursday, August 6, 2009

A Riley County child has been infected with a strain of swine influenza not commonly seen in humans, but has fully recovered following a mild illness.

No other cases have been identified, but an investigation is underway. The influenza strain that infected the child was identified as an H3N2 virus that commonly circulates in pigs in North America. It is different from the pandemic H1N1 virus, also of swine origin, that was first detected in the United States in mid-April.

"It is critical for people to understand that this H3N2 virus is not related to the pandemic H1N1 virus," said Jason Eberhart-Phillips, Kansas State Health Officer and Director of Health at the Kansas Department of Health and Environment (KDHE). "This is not a mutation or a recombination of the pandemic strain, and it does not appear at this time to be a threat to human health."

The child was likely exposed to the virus during the Riley County Fair in late July, where the child had direct contact with pigs. The child later developed influenza-like symptoms and sought medical care. The child has fully recovered and no other family members have reported illness.

KDHE is working closely with the Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA), the Riley County Health Department and the Kansas Animal Health Department to investigate this case.

KDHE and the local health department are working to determine if the Riley County Fair swine exhibitors, or their pigs, have been ill.Swine flu viruses do not normally infect humans, but human infections occur from time to time. Typically CDC has received reports of approximately one human infection with a swine influenza virus each year.

That number has risen slightly in the past few years. The increased number of reported cases this year is likely the result of increased influenza testing related to the H1N1 pandemic.

So far this year, 14 cases of human infections with swine influenza viruses have been reported in the United States. That number does not include the number of H1N1 cases, as the H1N1 virus has not been detected in swine in the U.S.

"Most instances of human infection with animal influenza viruses, like the swine H3N2 virus, do not result in human-to-human transmission," Dr. Eberhart-Phillips said. "However, each case needs to be fully investigated to be sure that the viruses are not spreading among humans."

Most commonly, cases of human infection with swine influenza occur in people with direct exposure to pigs, he added.

BANGKOK, Aug 6 — Thailand has stepped up its border precautions to guard against any possible outbreak after pneumonic plague has led to the deaths of three people in China.

According to the Thailand news agency (TNA), Public Health Minister Witthaya said he had assigned the the Disease Control Department to keep a close watch on measures being implemented in China against the plague, as well as monitor border to prevent animal carriers of the plague entering into Thailand.

“No special measures are being launched against the pneumonic plague. The World Health Organization (WHO) is monitoring the situation and we will follow its measures,” he said, when asked to comment on the pneumonic plague outbreak which killed three people in China’s Ziketan in the northwestern province of Qinghai.

Following the outbreak, the Chinese government has already ordered the town of more than 10,000 people sealed off to prevent the spread of the outbreak to other parts of China.

However, Witthaya added that the pneumonic plague can be spread only in a short period, unlike the influenza A(H1N1) in which the virus stays in human bodies for longer periods and can be transmitted to other persons.

“Untreated patients of pneumonic plague can die within 24 hours after contracting the plague,” said the minister, reports TNA.

Today, Thailand’s Department of Disease Control reported that no pneumonic plague found in rats at the Bangkok’s Klong Toey Port (Thailand’s major port for sea transport of cargo), after closely monitoring the Flea Index in the rats.

Veterinarian Plaiyong Sakaraseranee of the Disease Control Department said the agency laid 35 traps but only seven rats were snared and none of them carried pneumonic plague.

Thailand last recorded pneumonic plague in 1952, Dr Plaiyong said, adding that the department will continue to trap rats at 64 border checkpoints nationwide to evaluate the Flea Index.

He also urged the citizens to clean up their homes and urban living areas to prevent possible outbreak.

Pneumonic plague is caused by the bacteria ‘Yersinia pestis.’ In its spread the plague bacillus enters the skin from the site of the bite and travels through the lymphatic system to the nearest lymph node.

It is usually transmitted between animals and humans by the bite of infected fleas, direct contact, inhalation and only rarely, by eating or drinking infected food. – Bernama

PUTRAJAYA: Health authorities urged the public not to panic and stepped up measures to contain the Influenza A(H1N1) outbreak as the virus claimed its 14th fatality.

Health director-general Tan Sri Dr Ismail Merican said that as of 8am Thursday, the death toll had reached 14, the latest casualty being a 57-year-old pensioner who was a diabetic and suffered from hypertension.

He was warded at the intensive care unit at the Putrajaya Hospital on Aug 4 and succumbed to acute pulmonary oedema on Wednesday.

Health authorities also recorded 16 new cases in the last 24 hours; all were local tranmissions with two new clusters reported. The number of people who have been infected in Malaysia stood at 1,492.

[A note on John M. Barry:John M. Barry is a prize-winning and New York Times best-selling author whose books have won more than twenty awards. In 2005 the National Academies of Science named The Great Influenza, a study of the 1918 pandemic, the year’s outstanding book on science or medicine, and the Center for Biodefense and Emerging Pathogens gave Barry its 2005 “September Eleventh Award” for his contributions to pandemic preparedness.]

White Paper On Novel H1N1Prepared for the MIT Center for Engineering Systems Fundamentals

Note: This paper’s purpose is to provide a relatively in-depth understanding of the problem and the issues, now and as they change. Therefore, it omits an executive summary.

Contents:1. Background on the Influenza Virus2. The Epidemiological Picture and Cross-Protection as of Late June 20093. Antivirals and Vaccines4. Recent Non-Pharmaceutical Interventions and International Actions5. Communication6. The Past as Prologue: Waves and Patterns from Past Pandemics7. The Future of Novel H1N1

Thursday, August 6, 2009 - 14:56Conflict between statements made by the Council of Ministers and the World Health Organization

The statement issued by the central operations room status information and to support decision-making Council of Ministers on Thursday that Egypt is still in the initial phase of any virus (H 1 that 1) is known worldwide as the swine flu.

And is in accordance with the standards set by the Egyptian Ministry of Health with regard to the measurement of the intensity and seriousness of the disease, the number of cases, the proliferation of cases, clinical symptoms of the disease, and mortality disease.

The statement said: "The healing of the case 219 by 69.7% of the total cases of the disease, even yesterday, and there was one death, and enjoy the rest of the 94 cases and the situation in good health."

He added that the number of cases have been found infected with the disease in Egypt amounted to 314 as of yesterday evening, according to the results of the examination and laboratory data of the Ministry of Health, explaining the details of 16 recent cases, which include 12 state of Egyptian nationality, and 3 cases of Saudi nationality, including two coming from Saudi Arabia, and the state and one from Jordan. It also includes cases, one case with Vietnamese nationality, coming from Vietnam, pointing out that the introduction of these 16 recent cases to the hospital and were in stable condition.

The statement pointed out that the examination of 74 suspected case of swine flu in governorates (Cairo, Alexandria, South Sinai, the West, Damietta, Dakahlia, Sohag, the lake, Monoufia, Giza) and the laboratory results were all negative, as was the examination of 8 cases of suspected avian flu from 4 provinces and the laboratory results are negative.

On the deployment of some Internet sites that deal with a glass of anise warm than in the effectiveness of the drug Tamiflu, has denied the Ministry of Health said in a statement today, reports in this regard, stressing that the drug is still used as one of essential medicines for anti swine flu and reduces the severity and complications .

The ministry emphasized the need to consult doctors before taking up any medicine or treatment for swine flu in order to avoid any side effects on the health of citizens.

And questions about public opinion on whether it will be given the drug Tamiflu for bird flu cases to be dealt with domestic pigs during a certain stage in accordance with the plan of the Ministry of Health, the Ministry indicated that, according to the plan, during the third phase will be addressed part of the infected cases in the houses and the rest of the cases in hospitals , according to the criteria in this regard.

The Ministry of Health in accordance with the statement that the majority of cases will be treated at home would not take Tamiflu, which will be given only rare cases of real estate, while the property will be disbursed through the Ministry of Health of the cases treated in hospitals, which will be allocated to it.

It is noteworthy that the Ministry of Health has already said it developed a proposal for measuring the severity of the seriousness of the disease, according to several criteria: the number of cases, the proliferation of cases, clinical symptoms of the disease, disease and mortality rates, based on these criteria have been identified 3 stages of the disease in Egypt.

The Ministry of Health meeting Sunday attended by the detention of 4 new cases of hospital admitted Tanta on suspicion of being infected with bird flu after an outbreak of symptoms similar to symptoms of the disease, and was assigned to isolated places, where both were detained Mohamed Ibrahim Sbag (two), a dead child from the village over the status of Alsentp and, as God, as God's (27 years), the police of the village, Ziad Mahallat Center Smonod, Mahmoud Hany Mahmoud Gharib (3 years) from the village of Mahala Kfrhijazy Center, Ihab Mohamed Ihab (a year and a half) of the Mahalla al-Beshara Center.

تم أخذ عينة دم ومسحة حلق من المرضى، وإرسالها للمعامل المركزية الخاصة بوزارة الصحة لبيان مدى إصابتهم بالمرض من عدمه، وإعطائهم عقار التايمفلو. Blood sample was taken hours, survey of patients, and sent to the central laboratories of the Ministry of Health with the extent of illness or not, and give them the drug Altaymflo.

Detained in hospital Minshawi year two new suspected bird flu symptoms after an outbreak of pig disease and of their sense of high fever, bone pain and lack of breathing, the hospital where he was both the Amer-Fattah Abdel-Hamid (42 years) from the locality of the late officer, Mustafa Mohamed Hussein Shimi (23 years) without a working area of the copper Btnta Bonaparte.

Been isolated cases of places allocated to it and take a blood sample and swab their hours and be sent to the central factor, and the development of contacts are under observation, and the alarm continued to go to the nearest hospital was admitted or when they feel any symptoms of the disease.

The Directorate of Veterinary Medicine Menoufia campaign inspection within ten days all the shops and street vendors, which the 21117 birds culled, and the number of closed down 49 shops and seized a number of vendors, 210 vendors, as well as the demolition of 309 nest cities.

The crackdown came in the context of intensified efforts to combat bird flu and tightening control over markets, farms and surrounded the disease, and the cooperation between the province and the Directorate of Veterinary Medicine.

A new vaccine for swine flu is most likely to be targeted at vulnerable groups such as young children and pregnant women. But a Radio 4 documentary has discovered that little or no data exists on the safety or effectiveness of flu vaccines on these groups.

Holly Pyke, left, receives a swine flu vaccination by nurse Luiza Duszynski at the Royal Adelaide Hospital in Adelaide, AustraliaThere have been no trials of swine flu vaccines on pregnant women

In 1976 the US Government vaccinated 45 million people for a swine flu outbreak that never materialised.

But 500 people developed a rare neurological condition called Guillame Barre syndrome which left people in a coma and 25 died.

The reaction still mystifies health officials, including Peter Smith, Professor of tropical epidemiology at the London School of Hygiene and Tropical Medicine.

'Adverse reaction'

"Why that happened has never really been understood - it's not really been observed with subsequent influenza vaccines," said Professor Smith, chairman of the global advisory committee on vaccine safety at the World Health Organisation.

"There's been a lot of seasonal flu vaccines and they've not seen this same adverse effect at all and so that is a sort of lurking shadow in the US experience which I suspect influences the way in which they treat all new vaccines," he added.

Health officials and academics think it is highly unlikely that such an adverse reaction would happen again.

But it is a concern as authorities around the globe stand on the verge of a mass vaccination programme against the current pandemic.

Pregnant women and children are expected to be among the groups targeted for vaccination, especially in countries likely to ration their vaccines.

Yet paradoxically the hard scientific evidence about the efficacy or dangers of these vaccines on pregnant women and young children does not exist.

"There is no study of the vaccines on pregnant women - no randomised clinical trials," said epidemiologist Tom Jefferson, who reviews influenza prevention and treatment for The Cochrane Collaboration, the voluntary global database provided by healthcare professionals which monitors the effects of healthcare worldwide.

No trials

He added: "Under the age of two there is only one trial and it shows inactivate vaccines [vaccines based on killed organisms] don't actually work."

Dr Jefferson said the best effect of influenza vaccines was on healthy adults.

A further problem, he explained, was that flu vaccines are unique in that they are registered and approved before full scale clinical trials have taken place.

Neither will the possible side effects be known on pregnant women or young children as Dr Marie Paul Kieny, director of vaccine research at the WHO explained. "It's not to say they would not be safe, they may be very safe but there is no data for the time being to demonstrate safety."

Adam Finn, professor of paediatrics at Bristol University is waiting for the go-ahead to commence a study the UK"

"We urgently need to get some evidence from children because young children, particularly under five, do seem to be at risk of serious illness," says Professor Finn.

"And secondly there is clear evidence that flu epidemics and pandemics are spread very efficiently by children. Children simply infect each other and their parents very efficiently and for that reason a hugely effective strategy to controlling epidemics of this kind is to immunise children."

Priority patients

Professor Finn predicted that the vaccines would probably be more effective in older children although he said that is not to say deploying the vaccines in younger children has no value.

"A vaccine that works, albeit not so well, is still better than no vaccine at all," he added.

The results of these trials will not be ready for a few months, probably mid-October.

This poses a potential dilemma for the Dept of Health - whether to start vaccination before the trial's results are known. Officials declined to tell The Report whether they will wait for the end of the trial.

The US has already issued its priorities: adults under 24, pregnant women, healthcare workers and people with underlying conditions like asthma. The over 65s are at the end of the queue.

Find out more from The Report on BBC Radio 4, Thursday 6 August 2009 at 2000 BST. You can also listen via the BBC iPlayer after broadcast or download the podcast.

PUTRAJAYA, Aug 6 (Bernama) -- Another death related to Influenza A (H1N1), that of a 57-year old male pensioner at the Putrajaya Hospital Wednesday, has raised the number of deaths due to the pandemic to 14 since this morning.

Director-General of Health Tan Sri Dr Mohd Ismail Merican said the victim who had diabetes and hypertension was admitted to the hospital's intensive care unit (ICU) with symptoms of fever, cough and difficulty in breathing.

"He was confirmed having the virus yesterday. He died yesterday of Acute Pulmonary Oedema secondary to H1N1," he told reporters here Thursday.

In that regard, Dr Mohd Ismail again stressed that people with high risk like pregnant women, those with lung disease, obesity, diabetes, asthma, low immunity, heart disease and breathing difficulty to seek immediate treatment at the nearest clinic or hospital as treatment for Influenza A (H1N1) was very effective if treatment was started within 48 hours of onset of symptoms.

He said for those who have normal influenza symptoms and not in the high risk groups they are advised to not panic and rush to get themselves tested.

He said this was because many H1N1 cases in Malaysia, and the rest of the world, would show light symptoms and 98 per cent would recover even without specific medicine.

"Patients with light symptoms are asked to rest and God Willing will recover in three or four days. After recovering they will have the anti-body, so it is not necessary for all cases with light symptoms to undergo H1N1 testing," he said.

Dr Mohd Ismail said H1N1 testing would only be done for cases admitted to ward and those with high risk.

He said this was because the Institute of Medical Research (IMR) which is responsible for testing is swamped with 500 tests a day and that 80-90 per cent were tested negative